New hope for kids with juvenile chronic arthritis

Juvenile chronic arthritis, formerly known as juvenile rheumatoid arthritis, is the most common rheumatic disease in children, affecting 1 in 1,000 kids.

But thanks to advances in treatment, most kids with juvenile arthritis can lead active lives.

“We have many patients who continue to play sports, including one who runs track in college,” said Dr. Mary Toth, director of Pediatric Rheumatology at Akron Children’s Hospital. “It’s rare now to see kids with crutches or in wheelchairs.”

Juvenile chronic arthritis (JCA) is an autoimmune disease where the body’s immune system attacks its own joints. It can occur anytime up until age 16, but peaks between the ages of 1 and 3.

In the most common form, four or fewer joints are affected, typically large joints such as the knees, ankles or elbows. Girls are more likely to have a form of juvenile arthritis that affects five or more small joints, usually those in the fingers and hands.

There are other less common forms of JCA, which may affect other organs or be accompanied by a fever, rash or the skin condition, psoriasis.

Dr. Mary Toth

“When we see little ones with joint pain, juvenile chronic arthritis is often the cause, as very young children do not typically have joint pain due to overuse,” Dr. Toth said.

Often young children won’t complain of pain, but you may notice them limping and favoring the affected joint.

Symptoms of juvenile arthritis

To be juvenile chronic arthritis, there must also be swelling in the joints accompanied by tenderness and warmth. The pain isn’t severe, but usually a dull ache.

Other symptoms include:

Pain with motion

Morning stiffness that lasts longer than an hour

Stiffness following periods of immobility

“Unlike many adults, it’s unusual for a child to be stiff after sitting for a long period of time, such as after a long car ride. Normally, kids jump right up without a problem,” said Dr. Toth.

In some cases, these symptoms may be due to an infection and will go away once the infection clears. However, if they persist, Dr. Toth recommends talking to your child’s doctor to make sure it’s not JCA.

The exact causes of juvenile arthritis are unclear. Some children may have a genetic predisposition, even if others in the family aren’t affected.

In other cases, it may be triggered by an infection or trauma to the joints.

Treatment for juvenile arthritis

Because juvenile arthritis can cause short- and long-term disability and affect growth, early diagnosis and treatment are important.

Once a specific form of JCA is identified, treatment can help reduce symptoms and ensure children are able to participate in daily activities, including sports and other recreational activities.

“The goals of treatment are to control inflammation, relieve pain, prevent joint damage and help kids remain active,” said Dr. Toth. “New medications have been developed that have revolutionized treatment over the last decade.”

These new anti-inflammatory medications work by reducing inflammation in the joints to stop juvenile arthritis from progressing.

“If a patient doesn’t respond to one medication, we have several other options,” Dr. Toth said.

Along with medication, patients may receive physical or occupational therapy to help maintain the range of motion in their joints and to strengthen the muscles that support those joints. Splints may be used to help keep joints in the correct position and relieve pain.

Throughout treatment, patients are closely monitored to check their progress and any side effects from treatment.

Because kids with juvenile arthritis are at risk for uveitis, an inflammation of the eyes, a pediatric ophthalmologist also monitors them. Left untreated, uveitis can lead to blindness.

While there’s no cure for juvenile arthritis, about half of all kids will eventually go into remission as their immune system matures.

“Our patients who follow their prescribed treatments have the best chance for remission. But for some, staying on their medication is necessary to minimize pain and other symptoms so they can continue to remain as active as possible,” Dr. Toth said.

If your child has swelling or pain in the joints, talk to your child’s doctor who may refer you to a pediatric rheumatologist for an evaluation.

Akron Children's Hospital is one of the largest pediatric hospitals in the U.S., and ranked among the best children's hospitals by U.S. News and World Report.
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